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Bewitched, Bothered, & Bewildered
Harvard physicians delve into the past to diagnose a range of mysterious maladies, from the Salem Witch Trials, to the neurology of Vincent Van Gogh’s color choices, to Eugene O’Neill’s debilitating neurological disorder.
by Beverly Ballaro, Paula Byron, and Janice O’Leary

Witches’ Brew

For two days, the old man lay naked in the open field adjoining the jail where he and his wife had huddled miserably for the previous five months. He struggled to breathe under the weight of the heavy stones that his fellow villagers had placed, one by one, on a board covering his chest and abdomen. “Do you confess?” the sheriff repeatedly harangued Giles Corey, once even using his cane to force the prisoner’s bulging tongue back into his mouth.

But unlike many of the other victims of the 1692 Salem witchcraft hysteria, Corey, damned by a teenaged neighbor girl as “a dreadfull wizzard,” refused to be tortured into a confession. Given repeated chances to save himself (ironically, those who pleaded guilty and named other names escaped execution, while those who protested their innocence did not), Corey only gasped in reply, “More weight!”

Historians have suggested that what quickly escalated into a tragedy engulfing an entire community may have begun merely as an entertaining way for a small group of bored, impressionable young women and girls from Salem Village to pass a bitter winter. It is perhaps noteworthy that the first two accusers to display mysterious symptoms were also the youngest, children whose Puritan imaginations had been captivated by tales of magical arts told to them by Tituba, a local servant of West Indian and African descent.

Researchers have advanced various theories, including mass hysteria, conspiracy, and mental illness, to explain how the fascination of a few youngsters could have triggered events leading to the gruesome executions of Giles Corey and 19 others, with more than a hundred imprisoned. One of the most intriguing speculations, put forth by a number of historians, suggests that the origin of the accusers’ bizarre behavior, which many in their community perceived as a supernatural affliction, was actually agricultural.

Epidemics of ergot poisoning, labeled “St. Anthony’s Fire” in medieval times, have been documented throughout history. According to Alan Woolf, a medical toxicologist and an HMS associate professor of pediatrics at Children’s Hospital, people who ingest grain contaminated by the fungus Claviceps purpurea can suffer from some of the same unusual symptoms—seeing apparitions and feeling pinpricks, pinches, and burning sensations—described in the records of the Salem trials.

Proponents of the ergot theory, says Woolf, have offered other evidence as well. The weather during the period in question, for example, provided ideal conditions for the growth of ergot on rye. Three of the afflicted girls lived on a farm where ergot-contaminated rye might have flourished, and the records show that several cows in the area died during that time, suggesting a possible infection among the grazing livestock.

And yet a dubious Woolf and other skeptics see many flaws in that toxicological explanation. “A few cows died; so what?” Woolf wrote in a 2000 article on the subject for Clinical Toxicology. Moreover, Woolf points out, although some of the girls did indeed display some of the classical symptoms of ergot poisoning, none of them reflected the full constellation of expected signs and symptoms, which would include abnormalities of the arms and legs due to ergot-induced vasoconstriction. Also, unlike those suffering convulsive ergotism, they could stop and start their symptoms on demand. And no evidence of the typical residual effects of ergotism, such as weakness or dementia, ever appeared.

Further scuttling the theory that it was a mycotoxin that fueled the tragic events of 1692, Woolf raises a compelling point: “Other witchcraft trials besides Salem in New England brought 141 persons to trial between 1638 and 1699. Were they all suffering ergotism?”

Woolf believes that the evidence points rather to an emotionally charged web of political motivations, economic jealousies, bitter land disputes, and personal grudges. This climate of festering resentments provided ripe conditions for a tragic settling of scores between disgruntled adults who seized—and were seized by—the powerful fears and emotions stirred up by the girls’ odd behavior. On the dark January 1692 day when nine-year-old Elizabeth Parris and eleven-year-old Abigail Williams first began to startle those around them with fits of blasphemous screaming, convulsive seizures, and trance-like states—soon to be imitated by a number of their peers—they probably could not have imagined, in their childish way, the deadly campaign their subsequent babble of witches’ spells and demonic trafficking would soon unleash on their community.

And yet they had to live with the sobering legacy of their experience. Some 14 years after Giles Corey died for his stubborn refusal to yield a confession, one of his original accusers, Ann Putnam, by then a 26-year-old woman, offered a confession of her own: “It was a great delusion of Satan that deceived me in that sad time,” admitted Putnam in a statement she asked her minister to read aloud to the congregation one Sunday, “whereby I justly fear I have been instrumental to bring upon myself and this land the guilt of innocent blood.”

Beverly Ballaro was the associate editor of the Harvard Medical Alumni Bulletin from 2001 to 2005; before that, she served as the assistant editor for one year.

Image: BETTMAN CORBIS

Stars in His Eyes

When Vincent van Gogh began painting a starlit sky one night, he found that “putting little white dots on a blue-black surface” failed to capture the vision before him.

“It often seems to me that night is still more richly colored than the day, having hues of the most intense violets, blues, and greens,” he later wrote. “If only you pay attention to it you will see that certain stars are citron-yellow, others have a pink glow, or a green-blue and forget-me-not brilliance.”

It was the artist’s sensitivity to the nuances of hue that first drew Shahram Khoshbin, HMS associate professor of neurology at Brigham and Women’s Hospital, to van Gogh’s work. As a fine-arts student in Beirut, Khoshbin wrote his senior thesis on the painter’s florid use of tertiary colors, which emerge when a secondary color blends with a primary color.

“Through years of experimentation, van Gogh had discovered he could pair certain colors—such as blue-violet with yellow-orange—to evoke emotions,” says Khoshbin. “Such color combinations can trigger autonomic responses in viewers. When you stand before many of his paintings, your palms turn sweaty, your breaths come rapidly, and your heartbeat quickens.”

Despite his passion for art, Khoshbin ended up turning to medicine instead. Soon his growing fascination with neurology led him to ponder van Gogh’s behavior as well as his art. Dozens of diagnoses—from schizophrenia, to bipolar disorder, lead poisoning, and absinthe toxicity—had already been advanced to explain van Gogh’s vibrant paintings, eccentric life, and dramatic death. While a medical student at Johns Hopkins, though, Khoshbin seized the chance to ask the late Norman Geschwind ’51, a pioneer in behavioral neurology who was at Hopkins to give a lecture about Fyodor Dostoevsky, about van Gogh’s diagnosis. “That’s simple,” Geschwind replied, “he had epilepsy—just like Dostoevsky.”

Khoshbin felt surprised, even after he learned that van Gogh’s own doctor had diagnosed the artist with epilepsy, because he doubted the disease could account for the full range of van Gogh’s symptoms. But an incident the following year made that diagnosis resonate after all. While volunteering in an art-therapy studio, Khoshbin noticed that few of the patients used tertiary colors in their gouache paintings. One evening, as he was helping the janitor tidy the studio, he mentioned his observation. The elderly man walked him downstairs to a custodial closet filled with brooms, mops, and the rustling sounds of nesting rats. There the janitor pulled out boxes and boxes of artwork he had collected over the decades. On the back of each of the hundreds of paintings he had inscribed the artist’s diagnosis.

“The schizophrenics’ artwork was meticulous and detailed,” Khoshbin remembers. “The depressed patients had splashed black and brown everywhere. But what stunned me was the box filled with art by the epileptics: in almost every painting they had used tertiary colors.”

Years later, while working with patients who had suffered damage to the temporal lobe, Khoshbin discovered that they perceive colors as being brighter and images as more vivid than other people do. “Sensory integration takes place in the temporal lobe,” Khoshbin says, “so it’s easy to understand how a disturbance in that part of the brain can create a different sensory experience.”

Khoshbin now believes van Gogh suffered from not just temporal lobe epilepsy, but also a personality disorder associated with it, dubbed the Geschwind syndrome; in the early 1970s, Geschwind had identified a constellation of five personality traits: hypergraphia, or voluminous graphic output; hyper-religiosity; unstable sexual behavior; intermittent aggressiveness; and clinginess.

Van Gogh exhibited all five traits. His hyper-religiosity, for example, once led to his being fired from his job as an evangelist minister for “excessive zeal.” He alternated between periods of hypersexuality and hyposexuality and between liaisons with women and with men. His stormy relationship with the painter Paul Gauguin illustrated not only his clinginess—Gauguin bemoaned the difficulty of ending conversations with van Gogh—but also his aggression. It was just after threatening Gauguin with a razor that van Gogh famously lopped off part of his own earlobe and presented it with much flourish to a young lady of the night.

Dramatic, too, was van Gogh’s hypergraphia. A largely self-taught artist who didn’t start painting until the age of 27, he nonetheless created more than 2,000 works of art before his suicide a decade later. The year he described the vibrancy of colors in the night sky—and painted his masterpiece Starry Night—in fact, was so fertile he was producing, on average, a new painting, watercolor, or drawing every 36 hours. When he wasn’t clutching a paintbrush or stick of charcoal, he was grasping a pen, writing long letters far into the night.

Those letters reveal much about van Gogh, from his obsession with color to his instincts for the divine. “When I have a terrible need of—shall I say the word—religion,” van Gogh once wrote to his brother Theo, “then I go outside in the night to paint the stars.”

Paula Byron has been the editor of the Harvard Medical Alumni Bulletin since 1998.

Image of STARRY NIGHT: Corbis KIPA

 

A Long Day’s Journey into Night

One day, without warning, Eugene O’Neill’s hands jerked, causing the 55-year-old playwright to splash coffee on himself. He then burst into a fit of weeping, the result not of the accident, he wrote, but of a “nervous impulse.”

By that time, O’Neill, the only native-born American dramatist ever awarded a Nobel Prize for literature and the winner of four Pulitzer Prizes, had already been suffering for years from an array of mysterious symptoms. His handwriting had become micrographic, his gait unsteady, his limbs uncoordinated, and his speech impaired, all of which had a crippling impact on his life and art.

Although O’Neill had been diagnosed with Parkinson’s disease a dozen years before his death at the age of 65, an autopsy performed by the late E. P. Richardson, Jr. ’43A, revealed a more surprising neuropathology, which he kept confidential at the family’s request. Decades later, Richardson and Bruce Price, an HMS assistant professor of neurology and chief of neurology at McLean Hospital, secured permission from O’Neill’s surviving grandchildren to publish the postmortem findings. Their report appeared after Richardson’s death in the April 13, 2000, issue of the New England Journal of Medicine.

According to the report, O’Neill first noticed a tremor in his hands while a freshman at Princeton University, but it did not affect his writing until he was 41. Two years later, O’Neill noted in his diary his difficulty in controlling a pencil. His tremor continued to worsen so that by 1943, he stopped keeping his work diary because the physical process of writing had become torturous.

That same year, when someone commented on the shrunken quality of his handwriting, O’Neill explained, “There is a physical reason for that—the curse of Parkinson’s disease—it’s easier to control tremor in minute writing.” But, he added, what most disturbed him were the “fits of extreme melancholia that go with it. God knows I have had enough of Celtic Twilight in my makeup without needing any more of the same. And this isn’t the same. It isn’t sadness. It’s an exhausted, horrible apathy.”

O’Neill’s wife, Carlotta, described days when he could produce no more than a tremulous, illegible scrawl. “No one could read it but me,” she later recalled, “and I would type his manuscripts over and over for him. I nearly went blind.” Her husband added, “Now, Mrs. O’Neill, who has typed all my plays for years, has to operate with a magnifying glass and a book on Egyptology.”

Neurological examinations of O’Neill disclosed poor articulation in his speech and hypotonia of his muscles. His head and torso swayed, even while seated, unless held steady by his arms. Although his gait was wide with irregular foot placement, his posture remained erect. He exhibited no symptoms of dementia. Then, in 1952, O’Neill’s symptoms rapidly worsened; he had difficulty swallowing, became sullen and reclusive, and finally, a year later, contracted a fatal case of pneumonia.

The autopsy revealed an unscathed substantia nigra in the brainstem—the region most affected by Parkinson’s disease. The playwright suffered not from Parkinson’s, Richardson concluded, but rather an idiopathic form of late-onset cerebellar atrophy, with extension into the anterior lobes of the cerebellum.

Although O’Neill himself and many of his biographers suspected that his early alcohol binging might have caused his neuropathology, the New England Journal of Medicine article argues strongly against it. When alcoholism results in cerebellar degeneration, poor nutrition and chronic abuse are at the root. In this case, however, the authors write that O’Neill’s personal records reflect an adequate diet and suggest that O’Neill did not drink to excess for at least 25 years before his death and not at all during his last eight years. Other postmortem findings—a normal liver and testes, organs frequently damaged by chronic alcoholism—strengthen the argument against alcoholism as a factor in O’Neill’s disease.

The report does not rule out a genetic etiology—O’Neill’s family history hints at an essential tremor in his mother, a brother, and his older son—but the age and paucity of tissue specimens precludes DNA analysis.

Two decades before his death, O’Neill conceived the idea of a cycle of 11 plays intended as a critique of American civilization, caught, as he saw it, between its professed democratic ideals and the greed that fueled its progress. Plagued by his worsening disabilities, he completed only two plays, A Touch of the Poet and More Stately Mansions, in the proposed cycle. In the year before he died, O’Neill burned the remaining unfinished manuscripts. His wife described the tragic scene: “He could only tear a few pages at a time, because of his tremor, so I helped him. We tore up all the manuscripts together, bit by bit. It took hours…It was awful. It was like tearing up children.”

“Had O’Neill been able to fulfill his vision,” Price says, “the cycle of plays might have become one of the most extraordinary works of American theater. Instead, his neurological illness stole his abilities and his life, depriving us all.”

Janice O’Leary was assistant editor of the Harvard Medical Alumni Bulletin from 2004 to 2007.

This article appeared in the Spring 2005 issue of the Harvard Medical Alumni Bulletin.

Photo of Eugene O'NEILL: Hulton Archive/Corbis